Repeat Prescriptions

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How Do I.... Obtain A Repeat Prescription?

Please bring or post in (enclosing a stamped addressed envelope) your repeat prescription requests. They will be ready 48 hours after request. Sorry, we do not take prescription requests by telephone, but you may fax them to us on 0113 295 3417 or order them online (please ask at reception for further information).

THIS FORM BELOW IS CURRENTLY DISABLED - PLEASE USE ONE OF THE ALTERNATIVE METHODS MENTIONED ABOVE TO REQUEST PRESCRIPTIONS.

REPEAT PRESCRIPTION REQUEST FORM

* = Required field

First Names:

Last Name:

Date of Birth
(dd/mm/yyyy):

Email Address:

Phone Number:

Your Usual Doctor:

Please tell us the drugs you require. Be specific and check your spelling. Please take all details from your repeat prescription record slip.

Drug Name	Strength
*

If you require more than 10 items, please submit another request.

Collection Point :

Comments:
(any comments that you may have about this service, or additional medication)

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above*